Standardized bee venom preparation

ABSTRACT

Bee venom may be administered in a standardized formulation with or without relatively small amounts of anesthetic. In particular, the results of the combination of venom and anesthetic dramatically decreased pain and discomfort for patients undergoing apitherapy.

The present application is a continuation of U.S. patent applicationSer. No. 12/152,216, filed May 13, 2008, which is a continuation of U.S.patent application Ser. No. 10/690,772, filed Oct. 22, 2003, nowabandoned, which is a divisional of U.S. patent application Ser. No.09/615,437, filed Jul. 13, 2000, now abandoned, which claims the benefitof the filing date of U.S. Provisional Patent Application No.60/197,261, filed Apr. 14, 2000, now expired, the disclosures of whichare hereby incorporated by reference herein.

FIELD OF THE INVENTION

The present invention relates to the fields of medicine and pharmacy,and specifically to bee venom formulations and methods of making andusing same.

BACKGROUND OF THE INVENTION

Apitherapy is the medicinal use of various products of Apis mellifera(the common honeybee) including raw honey, pollen, propolis, beeswax,royal jelly and venom. Various studies attribute antibacterial,antifungal, anti-inflammatory, antiproliferative and anticancerpotentiating properties to honey.

In China, for example, raw honey is applied to burns as an antisepticand a pain killer. Recently, propolis has been identified as containingsubstances called caffeic esters that inhibit the development ofprecancerous changes in the colon of rats given a known carcinogen.Preparations from pieces of honeycomb containing pollen are reported tobe successful for treating allergies and bee pollen is touted as anexcellent food. This review focuses on related research materials aboutbee venom to treat chronic inflammatory painful illness.

Indeed, various forms of apitherapy have been used since ancient times.Ancient writers as diverse as Hesiod (800 BC), Aristophanes (450-388BC), Varro (166-27 BC) and Columella (First Century AD) all wrote on thecultivation of the hive. Hippocrates (460-377 BC), the Father ofMedicine, used it and call it Arcanum—a very mysterious remedy. Galan(131-201 AD), the Father of Experimental Physiology, mentioned it in histreatises on medicine. Charlemagne (742-814 AD) is said to have hadhimself treated with bee stings. The Koran (XVI:71) refers to bee venomin the following terms: “There proceeded from their bellies a liquorwherein is a medicine for men.” For apitherapy and the scientificunderstanding of bees, real progress began about 100 years ago whenphysician Phillip Terc of Austria advocated the deliberate use of beestings in his work: Report about a Peculiar Connection Between theBeestings and Rheumatism.

Today's proponents of apitherapy cite the benefits of bee venom andother bee derived products for alleviating chronic pain and for treatingmany ailments including various rheumatic diseases involvinginflammation and degeneration of connective tissue (e.g., several typesof arthritis), neurological disease (migraine, peripheral neuritis,chronic low back pain), autoimmune disease (multiple sclerosis, lupus)and dermatological conditions (eczema, psoriasis, herpes virusinfections). In contrast, interest in bees has been sporadic inconventional medicine, focusing mainly on two areas unrelated to thetherapeutic uses proposed above. These areas are: (i) the danger ofhypersensitivity reactions, including anaphylactic shock, from the stingof insects of the genus Apis; (ii) the use of bee venom itself asimmunotherapy for allergic reaction to such stings, especially toprevent life-threatening anaphylactic reactions in adults.

Despite the promise of apitherapy in alternative medicine circles, forthe reasons discussed above as well as the absence of standardized beevenom preparations and limited protocols for bee venom's effective use,the application of bee venom in mainstream medicine has languished. Inaddition to the foregoing, apitherapy is often painful. The use ofactual bees for the administration of bee venom can be dangerous anddifficult to control. It is also difficult for people to overcome theiraversion to insects and being stung. Even if administered by lesspainful techniques, such as by acupuncture, bee venom itself causes aunique combination of pain, burning and irritation. Such therapy canleave one asking whether the treatment is worse than the condition. Inview of the foregoing, there remains a need for standardizedformulations and methods for administering apitherapy to patients inneed of such therapies. Methods which avoid the use of actual bees andwhich can reduce the pain associated with apitherapy are particularlydesirable. It is to these problems that the present invention isaddressed.

SUMMARY OF THE INVENTION

In accordance with one aspect of the present invention, there isprovided a standardized bee venom preparation suitable foradministration by injection. This bee venom preparation comprises aliquid carrier which is mixed with between about 0.1 and about 10milligrams (mg) by weight of bee venom per milliliter (mL) of liquidcarrier. The preparation can also include excipients such as diluents,preservatives, buffers, viscosity modifiers, co-solvents and the like.Preferably, the bee venom will be provided in an amount of between about0.5 and about 5.0 mg per mL of liquid carrier.

Preferably, the bee venom will also include between about 0.01 and about1 mg of melittin and between about 80 to about 9500 micrograms (mcg)total protein per mL of carrier. Most preferably, the bee venom usedwill include between about 0.04 and about 0.05 mg of melittin andbetween about 800 to about 950 mcg total protein per mL of carrier.

Preferably, the standardized bee venom preparation in accordance withthe present invention is filtered through a 25 micrometer (mcm) filter(or better) so as to remove bacteria, bacterial debris, viruses andother contaminants. The formulations of this aspect of the presentinvention are sufficiently pure to provide safe and effective therapythrough a standard injection intradermally, subcutaneously orintramuscularly. They are more highly purified than other bee venompreparations known in the art. Yet they retain the most activecomponents of bee venom and may be obtained using commercially viabletechnology. They therefore represent a unique compromise of safety andefficacy as well as convenience and cost.

Another aspect of the present invention is the provision of compoundsuseful in apitherapy which greatly reduce the discomfort normallyassociated with apitherapy. Frequently, apitherapy involves multipleinjections of relatively small doses of bee venom at various sites. Byway of example only, 1 mL containing 1 mg of bee venom could beadministered in as many as 50 injections at the inflicted area andsurrounding same. About 0.1 mL doses, each containing 0.1 mg of beevenom, would therefore be delivered via each injection. Each of the 50injections can cause the pain, burning, itching and irritation, as wellas potentially swelling and inflammation normally associated with a beesting. These are collectively referred to herein as “irritation.” It hasbeen found that conventional topically applied anesthetics, areineffective in overcoming or reducing these unfortunate side effects.They can lessen the discomfort associated with being stuck by a needlebut they do little to mitigate the irritation caused by the injected beevenom.

It is quite unexpected, therefore, to find that anesthetics and inparticular, topical or local anesthetics, can be injected along with thebee venom, or shortly before or after, directly into the bee venom'sinjection site. When applied in this manner, even at doses andconcentrations far lower than those normally used for topical and localapplications for treatments as painful as bee venom, such as below 2%,it has been found that the irritation associated with the injection ofbee venom can be reduced appreciably. Indeed, while anesthetics may beused in amounts of 1 to 2% topically, much more is often required forvery painful procedures. It was very surprising to learn that amounts aslow as 2 mg/injection and less produced meaningful reductions indiscomfort. Indeed, it was particularly surprising to observe theseadvantages at only 10 times the amount of venom administered and below.

Not only was the amount of anesthetic used when applied in this fashionsurprising, so too was the way in which it acted. Anesthetics appliedtopically and intradermally would be expected, at these concentrationsand quantities, to provide some form of pain relief for only a fewmoments. They might help with the initial pain of the injection.However, bee venom can be very painful for as much as 10-15 minutesafter injection, much longer than such a small amount of anestheticshould be expected to provide any relief. Yet, it was surprisingly foundthat anesthetics applied as described herein can actually provideadequate pain relief long after the injection. Indeed, pain relief wasconsistent. That is to say that patients did not, after 5 or 10 minutes,suddenly realize a higher level of pain as the anesthetic wore off.

Therefore, compounds in accordance with this aspect of the presentinvention include a therapeutically effective amount of bee venom and atleast one anesthetic provided in an amount which is sufficient to reducethe irritation associated with the injection of the bee venom. In onepreferred aspect of the present invention, the bee venom and theanesthetic are intermixed and administered as a single preparation.However, the compound in accordance with the present invention may alsobe produced in situ, in the injection site, by first injecting a patientwith the appropriate amount of anesthetic and then the appropriateamount of bee venom or vice versa.

Generally, the anesthetic is provided in a ratio of between about 20:1to about 1:10 by weight relative to the weight of the bee venom.Preferably, the ratio is 10:1-1:10 by weight. However, more preferably,the anesthetic and bee venom are provided in a 3:1 to about a 1:1 weightratio. Both the bee venom and the anesthetic are preferably provided incombination with at least one excipient or at least one liquid carrier.The amount of bee venom generally present in each mL of the compounds ofthis aspect of the present invention range from between about 0.1 toabout 10 mg and the bee venom used is preferably the standardized beevenom preparation described above.

The present invention also relates to methods of administering bee venomto a patient so as to reduce the patient's discomfort during treatmentby administering, simultaneously or consecutively, as previouslydiscussed, both a therapeutically effective amount of bee venom and atleast one anesthetic. Both are administered intradermally,subcutaneously or intramuscularly and to the same injection sites (i.e.,if the anesthetic is administered intradermally to a specific spot on apatient's left knee, the bee venom is also administered intradermally tothat same spot).

The amount of anesthetic provided in accordance with these methods is anamount which is sufficient to reduce the irritation associated with theinjection of the therapeutically effective amount of bee venom.Typically, each injection in accordance with these methods will deliverbetween about 0.01 to about 1.0 mg of bee venom and more preferablybetween about 0.05 to about 0.5 mg per injection. Most preferably, about0.1 mg would be administered per injection. The total amount of beevenom administered per treatment session will depend upon the number ofinjections. Similarly, the amount of anesthetic administered perinjection will range from between about 0.01 to about 10 mg and morepreferably between about 0.10 to about 1.0 mg per injection. Mostpreferably, the amount of anesthetic administered will be about 0.1 mgto about 0.3 mg per injection.

In another aspect of the present invention, there are provided methodsof treating rheumatoid, osteo, gouty, psoriatic arthritis, ankylosingspondylitis, fibromyalgia, fibromyositis, myofascial dysfunction painsyndrome, tennis elbow, golfer's elbow, frozen shoulder, bursitis,tendonitis, chronic surgical inflammation of soft and bony tissue,peripheral neuritis, neuralgia, migraine, eczema, psoriasis, multiplesclerosis and lupus as well as other autoimmune, neurological,dermatological and degenerative diseases by the administration of beevenom preparation in the pharmaceutical compounds as described above.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Bee venom, in accordance with the present invention, generally refers tothe venom of Apis mellifera (the honeybee). The general composition ofbee venom is provided in Table 1 below.

TABLE 1 Typical biochemical compositions of the bee venom % (DRYDESCRIPTION COMPONENT MOL. WT. VENOM) Peptides Melittin 2,840 40-50Apamin 2,036 2-3 MCD-Peptide (Peptide 401) 2,588 2-3 Adolapin 11,500 1.0Protease Inhibitor 9,000 <0.8  Secarpin 0.5 Tertiapin 0.1 Melittin F 0.01 Procamine A, B 1.4 Minimine 6,000 2-3 Cardiopep? <0.7  EnzymesHyaluronidase 38,000 1.5-2.0 Phospholiase A2 19,000 10-12 α-Glucosidase170,000 0.6 Acid 55,000 1.0 Phosphomponesterase Lysophospholipase 22,0001.0 Physiologically Histamine 0.6-1.6 Active amines Dopamine 0.13-1.0 Norepinephrine 0.1-0.7 Nonpeptide Carbohydrates: Components Glucose andFructose <2.0  Lipids: 6 Phospholipids 4-5 Amino Acids: γ-AminobutyricAcid <0.5  β-Aminoisobutyric Acid <0.01

By weight of the dry venom, the most significant component is a peptideknown as melittin which is known to stimulate the hypophyseal-adrenalsystem and produces cortisone. It is 100 times more potent thanhydrocortisone. Melittin is also known to stabilize lysosome cellmembranes which provide protection against inflammation. The other mainpharmacological components include apamin, MCD-peptide (also known aspeptide 401), adolapin and various protease inhibitors. Apamin workslike melittin. It also inhibits the complement system, C₃, which isinvolved in inflammation. MCD-peptide blocks arachidonic acid andinhibits prostaglandin synthesis. Adolapin inhibits microsomalcyclooxygenase. It also inhibits lipoxygenase and thromboxane. Proteaseinhibitors inhibit carrageenin, prostaglandin E₁, bradykinin andhistamine induced inflammation, amongst other effects. Therefore, theterm “bee venom” as used herein also refers to the administration of oneor more of the pharmacologically active components of bee venom, such asmelittin or a combination of melittin and peptide 401. The term “beevenom” also, of course, refers to whole venom, as well as to, in theappropriate context, venom or components thereof prepared and purifiedin accordance with the present invention.

Unlike conventional forms of apitherapy which utilized bee stings, thestandardized bee venom preparations preferred in accordance with thepresent invention are mixed with a liquid carrier. Any carrier which cansolublize dried pure bee venom and which is pharmaceutically acceptablefor intradermal, subdermal or intramuscular administration may be usedin accordance with the present invention. Most preferably, such carriersinclude sterile and/or deionized water and physiological salinesolution, i.e., those containing about 0.9% sodium chloride. Generally,the amount of liquid carrier useful in accordance with the presentinvention is sufficient to provide a concentration of between about 0.1to about 10 mg of bee venom per mL. More preferably, the amount ofliquid carrier is sufficient to provide a concentration of between about0.5 and about 5 mg of bee venom per mL. Most preferably, the mixture ofliquid carrier and bee venom results about 1 mg of bee venom per mL. Forexample, 1 g of dried bee venom can be diluted in 1 L (1,000 mL) ofnormal, injectable, physiological saline (0.9% NaCl). Preferably, thisis done at about 20° C. inside a sterile room. The result is a solutioncontaining 1 mg of bee venom per mL. Preferably, the bee venom inaccordance with the present invention is whole bee venom.

After filtering through a 25 mcm filter, the standardized bee venompreparation preferably includes between about 0.01 to about 1.0 mg ofmelittin and about 80 to about 9,500 mcg total protein per mL. Morepreferably, the resulting pharmaceutical compound includes between about0.01 to about 0.10 mg of melittin and about 400 to about 4,500 mcg totalprotein and most preferably, between about 0.04 to about 0.05 mg ofmelittin and about 800 to 950 mcg of total protein per mL. Mostpreferably, the bee venom in question will exhibit 40 to 100 HHU/mL ofHyaluronidase activity (diluted to 100 mcg/mL) and is capable ofinhibiting gelatin induced aggregation of erythrocytes of 3-5 mm/H.

It will be appreciated that any purification means may be utilized toprovide bee venom of similar purity as that resulting from a 25 mcmfilter. Such methodologies include normal and reverse phasechromatography, affinity chromatography, recrystallization,immunochemical precipitation, membrane permeation methods as well asother filtration methods.

In addition to the liquid carrier, the bee venom preparations inaccordance with the present invention may include other conventionalexcipients including viscosity modifiers, preservatives and additivessuch as sodium chloride, various saccharides and the like. Theseexcipients include, without limitation, benzyl alcohol andmethylparaban, Ringers solution and other physiologically acceptablematerials commonly used in injectable therapeutics.

Typical formulations in accordance with this aspect of the presentinvention include 1.0 mg of pure dried Apis mellifera venom and 9.0 mgof sodium chloride per each mL of water. Another preferred formulationcomprises 1.0 mg of pure dried Apis mellifera venom, 9.0 mg of sodiumchloride and 0.009 mL of benzyl alcohol plus 0.991 mL of water. Again,these formulations are preferably filtered through a filtering devicewhich will exclude anything over at least 25 mcm. The use of even finergrade filtering is also contemplated.

When used alone for the treatment of various conditions such asarthritis or multiple sclerosis, or the relief of joint or back pain,for example, multiple doses are typically administered. Generally, beevenom is administered over a course of six to twelve weeks in one ormore sessions per week and a number of injections can increase from oneor two injections to twenty to fifty or more injections per session. Theamount of bee venom, as described herein, which may be administered witheach injection may range from between about 0.01 to about 1 mg.Preferably, the amount of bee venom administered is between about 0.05and about 0.5 mg per injection, and more preferably about 0.1 mg perinjection. Thus, 1 mL of either of the two formulations describedimmediately above can be provided in 10 divided doses of 0.1 mL eachwith each dose delivering 0.1 mg of bee venom.

Generally in accordance with the present invention, the bee venomcontaining solution is administered intradermally using a suitablesterile syringe with 0.1 mL graduations and a 25 or 27 gauge needle. Theneedle should generally range from between about ¼″ to about ⅝″ long. Itis appropriate to undertake skin testing of the patient before the firsttreatment to determine possibility of allergic reaction. A suitabletesting area such as the flexor surface of the forearm is used at about½ of the normal dose, or 0.05 mL, slowly injected to make a smallhemispherical bleb. The interpretation of the skin response is based onthe size of wheal, size of erythema and the appearance of irregularspreading, pseudo-pod projections from the test area. A normal responseappears when there is a pinpoint blood spot which indicates needleinsertion, a wheal having a diameter of 0.5 to about 1.0 cm anderythematous changes from about 1″ to about 2″ surrounding the injectionsite. If no systemic reactions occur within 15 to 30 minutes afterinjection, the test is considered negative.

When administering intradermally, prior to injection, it is oftenadvisable to withdraw the plunger and observe for blood entering thesyringe to avoid intravascular injection. The injections are given indifferent places dependent upon the affliction. However, for thepurposes of mitigating pain and treating arthritis, for example, theinjections are given in the painful area first. Most preferably, theinjections are given to the tender point or trigger points. Later, onemay give injections to the spinal area according to the dermatome chartfor maximum effect. Generally, during the course of treatment, alcoholconsumption is forbidden, ice packs or mentholated ointment may beapplied if local reactions occur and if generalized itching occurs,Benadryl may be taken, preferably in the amount of about 75 mg atbedtime and about 50 mg during the day. Acetaminophen or otherantipyretics may be taken as indicated for low grade fever or chills.

This invention also contemplates an apparatus for the collection ofvenom from honeybees in the purest way using a low voltage electricshock method. The extractor consists of two wooden frames one inside theother. The electric wires are attached to the front surface of the outerframe and the wires are alternately grounded and charged. When a beecomes into contact with two consecutive wires it completes the circuitbetween the wires and as a result is shocked.

The extractor is placed in front of the hive and connected with anelectric timer to a nine volt battery. When the battery is connected,current is allowed to flow alternatively, five seconds on and threeseconds off. As soon as the device is turned on, the bees in the hivesget excited and start to come out to attack the extractor. At the sametime, they spread pheromones into the air which makes other bees angry.When the bees get the electric shock, they bend their lower abdomen andforce their stingers into a silicone rubber sheet stretched across oneportion of the inner frame. When electricity is off for three seconds,they withdraw their stinger so that they do not die. Pure liquid beevenom is deposited on the underside of the silicone rubber sheet. Theinner frame is removed from the outer frame and placed in a sterile box.

The box can be placed in the sterile refrigerator (4° C.) for four tosix hours to allow it to air dry. The inner frame will then be taken outof the box and placed in a large sterile cage. Dried venom crystals areeasily scraped off using a medical blade. The collected crystallizedvenom is then put in a sterilized bottle and it is sealed. The venom mayalso be collected as described in U.S. Pat. Nos. 4,739,531 and3,163,871, the text of which is hereby incorporated by reference.

The use of the standardized formulations in accordance with the presentinvention in the treatment of various conditions, particularly thosedescribed herein, represents a significant advancement over the art.However, being stung by a bee is not a pleasant experience. Being stung30 times or more certainly raises the level of discomfort. The painfulburning sensation experienced by the use of bee venom is unlike otherforms of pain and irritation. And while standardized formulationsadministered intradermally, as preferred in accordance with the presentinvention, is far more palatable than actual bee stings, the irritationassociated with the administration of bee venom can still represent adeterrent to the use of apitherapy. Therefore, in a preferred aspect ofthe present invention there is provided compositions and methods whichmitigate, reduce and, in some instances, even eliminate the irritationassociated with the injection of bee venom. This discovery issurprising. First, the use of anesthetics and, in particular, topicallyapplied local anesthetics, does not provide relief from the burning,stinging and other forms of irritation which generally result from, forexample, intradermal introduction of bee venom. Yet the concurrent orsimultaneous administration of an anesthetic to the same injection sitedoes result in relief.

Unfortunately, the introduction of an anesthetic in this way was foundto generate problems not otherwise anticipated. For example, when anappropriate amount of a 2% solution of lidocaine was used, (20 mg/mLlidocaine:1 mg/ml bee venom) significant relief from the stinging,burning and other forms of irritation associated with the intradermaladministration of bee venom was realized. However, the lidocaine itselfcaused irritation which was not associated with the bee venom. Theresult was a significant improvement over the use of bee venom alone.However, the fact that lidocaine used in amounts which were typicallyappropriate for, for example, topical or local use, could be associatedwith additional irritation when used in combination with bee venom wassurprising.

It was also unexpectedly found that one could reduce the relative amountof anesthetic introduced to levels far below those generally used intopical and local applications (i.e., 1% and below) resulting in both asignificant reduction in the irritation associated with the injection ofthe bee venom and, at the same time, the elimination of the irritationassociated with, for example, intradermal administration of theanesthetic.

In accordance with this aspect of the present invention, the bee venomused may be that described previously or any other bee venompreparation, purified, filtered or not. The pharmaceutical compounds inquestion may include the anesthetic mixed into a single solution andadministrated in a single syringe. It is not necessary, however, thatthe bee venom and the anesthetic be injected in a single formulation oreven simultaneously. The anesthetic can be formulated separately andadministered to the same injection site either after or, morepreferably, immediately before the injection of the bee venom. Whenconsecutively administered, it is preferable that the anesthetic beinjected no more than an hour before and no longer than 10 minutes afterthe introduction of the bee venom. More preferably, when consecutivelyadministering the bee venom and anesthetic, the anesthetic isadministered within 10 minutes of the bee venom, preferably, within justa few moments before or after. Most preferably, the anesthetic isadministered immediately before or immediately after the bee venom.

If the bee venom is to be administered intramuscularly, then theanesthetic should also be administered to the same injection siteintramuscularly. The same thing holds true for subdermal or subcutaneousand, most preferably, intradermal administration.

The degree to which irritation associated with the injection of the beevenom is reduced is somewhat subjective. It would depend on a number offactors such as, for example, the individual patient's threshold forpain, the number of injections and the amount of bee venom administeredwith each injection, the location of the injection site and the depth ofinjection, intradermal, subcutaneous or intramuscular. However,generally speaking, by the use of an appropriate amount of anesthetic asdescribed and claimed herein, the degree of irritation will be reducedrelative to the administration of the same dose, in the same protocol tothe same patient without the anesthetic.

Anesthetics in accordance with the present invention include anycompound which can reduce the irritation associated with the injectionof bee venom. Anesthetics need not be topical or local anesthetics.However, such anesthetics are preferred. In particular, anestheticsuseful in accordance with the present invention include: Ambucaine,Amolanone, Amylocalne Hydrochloride, Benoxinate, Benzocaine,Betoxycaine, Biphenamine, Bupivacaine, Butacaine, Butamben,Butanilicaine, Butethamine, Butoxycaine, Carticaine, ChloroprocaineHydrochloride, Cocaethylene, Cocaine, Cyclomethycaine, DibucaineHydrochloride, Dimethisoquin, Dimethocaine, Diperodon Hydrochloride,Dyclonine, Ecgonidine, Ecgonine, Ethyl Chloride, Etidocaine, β-Eucaine,Euprocin, Fenalcomine, Fomocaine, Hexylcaine Hydrochloride,Hydroxytetracaine, Isobutyl p-Aminobenzoate, Leucinocaine Mesylate,Levoxadrol, Lidocaine, Mepivacaine, Meprylcaine, Metabutoxycaine, MethylChloride, Myrtecaine, Naepaine, Octacaine, Orthocaine, Oxethazaine,Parethoxycaine, Phenacaine Hydrochloride, Phenol, Piperocaine,Piridocaine, Polidocanol, Plidocanol, Pramoxine, Prilocalne, Procaine,Propanocaine, Proparacaine, Propipocaine, Propoxycaine Hydrochloride,Pseudococaine, Pyrrocaine, Ropivacaine, Salicyl Alcohol, TetracaineHydrochloride, Tolycaine, Trimecaine, and Zolamine. The most preferredof these, in accordance with the present invention, is lidocaine.

Understandably, the amount of anesthetic used is generally controlled bythe amount of bee venom used. However, the amount may need to beadjusted based on the specifics of the patient's condition, sensitivityto pain or the exact course of treatment. Generally, the amount ofanesthetic is provided in a ratio of between about 20:1 to about 1:10 byweight relative to the weight of the bee venom. More preferably, theanesthetic is provided in a ratio of about 10:1 to about 1:5 by weightand more preferably between about 3:1 to about 1:1 by weight.

The liquid carriers and/or excipients used to formulate the anestheticin accordance with the present invention may be the same or different asthat used in formulating the bee venom. It is also possible that theanesthetic is a liquid or is purchased in a formulation in which it ispremixed with one or more carriers and/or excipients. In that case, noadditional carriers or excipients need be used for the anesthetic.Furthermore, these types of anesthetic formulations could themselves beused as the carrier for the bee venom or mixed with a liquid bee venomformulation such as that described above.

The amount of anesthetic administered is preferably between about 0.01and about 2.0 mg per injection and more preferably between about 0.05and about 1.0 mg per injection. Most preferably, the amount ofanesthetic administered in each injection is about 0.1 mg per injection.

Typical formulations include: (1) each mL contains pure dried Apismellifera venom 1.0 mg, sodium chloride 9.0 mg, and lidocainehydrochloride 1.0 mg in 1 mL water for injection; (2) each mL containspure dried Apis mellifera venom 1.0 mg, sodium chloride 9.0 mg,lidocaine hydrochloride 1.0 mg, and benzyl alcohol 0.009 mL in 0.991 mLof water for injection; and (3) each mL contains pure dried Apismellifera venom 1.0 mg, sodium chloride 9.0 mg, lidocaine hydrochloride1.0 mg and methylparaban 0.1 mg in 1 mL of water for injection.

EXAMPLES

All of the patients in the following examples had been previouslytreated with standard medical therapies and yet significant painpersisted. Multiple medications including analgesics, muscle relaxants,non-steroidal anti-inflammatories, various injections, chiropracticmanipulation, physical therapy, and even surgery often failed to relievepatients medical conditions and in particular, their pain.

The examples were performed using a bee venom/lidocaine dosage form of0.1 mL per injection of a solution of 1:1 bee venom to lidocaine foreach dose given from the sixth session on. Prior sessions used bee venomalone. The solutions were formulated with normal saline (9.0 mg/mL) andwas filtered through a 25 mcm filter. Each patient was injected withindividual injections of 0.1 mL per injection. The number of injectionsvaried with the condition and number of treatments.

In each of the examples, the patients were treated by intradermalinjections with formulations in accordance with the present inventiontwice a week on average for 12 to 20 sessions. In the followingexamples, “RA Titer” is a blood test commonly used in diagnosis ofRheumatoid Arthritis. A titer score of less than 20 is considerednegative which is, in this case, a desirable result. “ESR” stands for“erythrocyte sedimentation rate” which is used as an indicator of aninflammatory condition. Normal is considered on a scale of 1 to 10.Anything higher is problematic and indicates generalized inflammation.

“ROM” means range of motion. The standard for range of motion changesdepending on the joint in question. However, the greater the distancebetween the two end points, the greater the range of motion. Tendernessand swelling are graded on a standard scale using plus signs. Each plussign generally indicates approximately 20%. The maximum number ofplusses (5) indicate a maximum amount of tenderness and/or swelling.“VAS” stands for visual analog scale. This is a method widely recognizedfor pain measurement. The most common VAS consists of 100 mm horizontalline with two end points labeled no pain and worst pain ever. Thepatient is requested to place a mark on the 100 mm line at the pointwhich corresponds to the level of pain intensity he or she presentlyfeels. The distance in millimeters from the low end of the VAS to thepatient's mark is used as the numerical index of severity of pain. Thisprocedure has been published in Churchill Livingston, Textbook of Pain,New York, 3d ed. 1994 338-339 and in Lea and Febiger, The Management ofPain, Philadelphia, 2d ed. 1990 581-582.

Example 1 Rheumatoid Arthritis (RA)

NG is a 39 year old female who suffered from RA for 19 years. She triedevery possible treatment including a cancer therapy drug to help hercondition. The pain and swelling in her hands and wrists were unbearableand she became disabled. She had 24 sessions of therapy in accordancewith the present invention with 95% improvement. Her conditionstabilized and no more pain and swelling was noted.

Before Treatment After Treatment RA Titer (<20 = Negative) 268  18 ESR(Normal: 0-10) 49  7 ROM (Flextion: 0-70) Wrist - Rt: 15, Wrist - Rt:55, Lt: 10 Lt: 60 Tenderness & Swelling +++++ + VAS (Pain Index) 98 15

Example 2 Osteoarthritis

HR is a 75 year old female who suffered from degenerative arthritis forover 25 years. Her knees and spine were more involved than other joints.She had 18 treatments in accordance with the present invention and hercondition markedly improved. She stopped taking all the medications andis doing well.

Before Treatment After Treatment Tenderness & Swelling +++  0 ROM(Fl-Ext: 0-120) Knees - Rt: 60, Knees - Rt: 100, Lt: 75 Lt: 110 VAS(Pain Level) 73 16

Example 3 Ankylosing Spondylitis

MO is a 53 year old female who had long-standing low back problems andmultiple operations with fusions. She had 18 months rehabilitationtherapy without relief. She had a total of 26 treatments in accordancewith the present invention with moderate improvement. No moremedications were needed. Follow-up visits monthly when it is necessary.

Before Treatment After Treatment Tenderness & Swelling +++++ + VAS (PainLevel) 95 20

Example 4 Fibromyalgia

PA is a 32 year old female who suffered with Fibromyalgia. All priormedical and psychological treatments were unsuccessful. Trigger pointinjections were given in multiple areas. Total 16 treatments withcomplete relief. Note—a “trigger point” is an area which, whenstimulated, causes a sudden pain in a specific area.

Before Treatment After Treatment Multiple Trigger Points 14 0 VAS (PainLevel) 82 17

Example 5 Tennis Elbow

JK is a 43 year old male who suffered from “Tennis Elbow” for 4 years.Conventional approaches failed. After a total of 12 treatment sessionswith formulations in accordance with the present invention, his recoverywas nearly complete.

Before Treatment After Treatment Tenderness & Swelling +++++ + VAS (PainLevel) 65 0

Example 6 Frozen Shoulder (Adhesive Capsulitis)

BO is a 56 year old male with Frozen Shoulder. Medications, injectionsand an operation failed. His range of motion was limited to 20% withconstant pain. After 14 treatment sessions with formulations inaccordance with the present invention, his recovery was complete.

Before Treatment After Treatment Tenderness ++++ 0 ROM Limited to 20%Full Motion VAS (Pain Level) 85 5

Example 7 Chronic Surgical Inflammation

BC is a 49 year old male who had more than 10 abdominal surgeries due tobleeding ulcers, alcoholic chirrosis and intestinal obstructions. Due toa phantom gallbladder pain and surgical pain, he was heavily addicted tomedications. After 28 treatment sessions with formulations in accordancewith the present invention, and with the injections concentrating atsurgical scars, relief was nearly 100%.

Before Treatment After Treatment Tenderness +++++ + VAS (Pain Level) 9214

Example 8 Postherpetic Neuralgia (PHN)

JP is a 78 year old female who suffered from shingles. Medical andsurgical treatments failed. She experienced a nearly 90% improvementafter 16 treatments in accordance with the present invention. Note—a“bleb” is a blister or bulla.

Before Treatment After Treatment Blebs at Thoracic Area +++  0Hypersensitivity (Touch) +++++ + VAS (Pain Level) 100 28

Example 9 Psoriasis

TH is a 28 year old male who suffered from psoriasis for 7 years.Medications were helping only temporarily. His condition was severe, sothat he could not wear short pants even on hot summer days. After atotal of 24 sessions, marked improvement was realized. Follow-uptreatment was required at least once a month.

Example 10 Multiple Sclerosis (MS)

SR is a 47 year old female with multiple sclerosis for 15 years. Despiteall the conventional treatments, her condition progressively worsened.She continuously felt tingling and numbness in her legs, lost 40% ofbladder control, lost strength in her extremities and her balance was soterrible that she had to depend upon a cane or walker. After a total of28 treatment sessions, a marked improvement was observed in hercondition. Her bladder control is now 100% and she no longer needs acane or walker. She requires follow-up visits every 3 to 4 weeks forforeseeable future.

Before Treatment After Treatment Muscle Weakness ++++ + Spasticity +++++++ Bladder Control 60% 100% Balance Poor Good Using a Cane or Walker YesNo

Example 11 Pain

Thirty patients, including the 10 patients described in Examples 1-10were treated with the appropriate amount of bee venom alone for thefirst five (5) sessions. All subsequent sessions (number varied frompatient to patient) were treated with a solution of 1:1 bee venom tolidocaine as described under the general heading “Examples” above.Patients were never told which formulation they were given and patientswere asked about the level and type of pain and discomfort realizedafter each treatment. Patients were also checked for body language,degree of wincing, reluctance to treatment, etc.

97% of patients objectively reported lower injection site pain anddiscomfort using the venom/lidocaine formulation. There was less fearabout further injections, and since using this invention, the number ofpatients who drop out of treatment has dropped dramatically. The painrelief was consistent in that patients did not experience a suddenincrease in pain as would be expected from the relatively short livedpain relief otherwise expected for small doses of these types ofanesthetics.

1. A standardized bee venom preparation comprising a liquid carrier,from about 0.1 milligram (mg) to about 1.0 mg of pure melittin, and fromabout 400 microgram (mcg) to about 4,500 mcg of total protein permilliliter (mL) of said standardized bee venom preparation, wherein saidstandardized bee venom preparation exhibits 40 to 100 honey beehyaluronidase units per mL (HHU/mL) of hyaluronidase activity whendiluted to 100 mcg/mL and is capable of inhibiting gelatin inducedaggregation of erythoricytes of 3-5 millimeter per hour (mm/H).
 2. Thestandardized bee venom preparation of claim 1, wherein the liquidcarrier is sterile deoinized water or physiological saline solution. 3.The standardized bee venom preparation of claim 1, further comprising anexcipient selected from the group consisting of a viscosity modifier,preservative, additive, sodium chloride, saccharide, benzyl alcohol,methyl paraban and mixtures thereof.
 4. The standardized bee venompreparation of claim 1, further comprising an anesthetic.
 5. Thestandardized bee venom preparation of claim 4, wherein said anestheticis selected from the group consisting of ambucaine, amolanone,amylocalne hydrochloride, benoxinate, benzocaine, betoxycaine,biphenamine, bupivacaine, butacaine, butamben, butanilicaine,butethamine, butoxycaine, carticaine, chloroprocaine hydrochloride,cocaethylene, cocaine, cyclomethycaine, dibucaine hydrochloride,dimethisoquin, dimethocaine, diperodon hydrochloride, dyclonine,ecgonidine, ecgonine, ethyl chloride, etidocaine, β eucaine, euprocin,fenalcomine, fomocaine, hexylcaine hydrochloride, hydroxytetracaine,isobutyl p aminobenzoate, leucinocaine mesylate, levoxadrol, lidocaine,mepivacaine, meprylcaine, metabutoxycaine, methyl chloride, myrtecaine,naepaine, octacaine, orthocaine, oxethazaine, parethoxycaine, phenacainehydrochloride, phenol, piperocaine, piridocaine, polidocanol,plidocanol, pramoxine, prilocalne, procaine, propanocaine, proparacaine,propipocaine, propoxycaine hydrochloride, pseudococaine, pyrrocaine,ropivacaine, salicyl alcohol, tetracaine hydrochloride, tolycaine,trimecaine, zolamine, and mixtures thereof.
 6. The standardized beevenom preparation of claim 4, wherein said anesthetic is lidocaine. 7.The standardized bee venom preparation of claim 4, wherein the amount ofsaid anesthetic provided is in a ratio of between about 20:1 to about1:10 by weight relative to the weight of said standardized bee venompreparation.
 8. The standardized bee venom preparation of claim 7,wherein the amount of said anesthetic provided is in a ratio of between10:1 to about 1:5 by weight relative to the weight of said standardizedbee venom preparation.
 9. The standardized bee venom preparation ofclaim 8, wherein the amount of said anesthetic provided is in a ratio ofbetween 3:1 to about 1:1 by weight relative to the weight of saidstandardized bee venom preparation.
 10. A method of treating rheumatoid,osteoarthritis, gouty arthritis, psoriatic arthritis, psoriasis,ankylosing spondylitis, fibromyalgia, fibromyositis, myofascialdysfunction pain syndrome, tennis elbow, golfer's elbow, frozenshoulder, bursitis, tendonitis, chronic surgical inflammation of softand bony tissue, peripheral neuritis, neuralgia, migraine, eczema,psoriasis, multiple sclerosis or lupus comprising administering thestandardized bee venom preparation of claim 1 to a patient in needthereof.
 11. The method of claim 11, wherein the standardized bee venompreparation of claim 1 is administered to a patient via the intradermal,intramuscular, subdermal or subcutaneous route.